Fluid–structure interaction (FSI) analyses of cerebral aneurysm using patient-specific geometry with uniform and pathological aneurysmal wall thickness models are carried out. The objective is to assess the influence of the wall thickness on the FSI and hemodynamics in aneurysms. Two aneurysm models that were reconstructured based on CT images are used. The arterial wall thickness is set to 0.3 mm for the non-aneurysmal artery and to 0.05 mm for the aneurysmal wall based on experimental findings. Another set of aneurysm models with a uniform wall thickness of 0.3 mm for the entire model is used for comparison. The FSI simulations are carried out using the deforming-spatial-domain/stabilized space–time method with physiological inflow and pressure profiles. Computations with different aneurysmal wall thicknesses depict considerable differences in displacement, flow velocity and wall shear stress (WSS). The wall displacement for the pathological wall model is 61% larger than that of the uniform wall model. Consequently, the flow velocities in the aneurysm with the pathological wall model are lower, and that results in a 51% reduction in WSS on the aneurismal wall. Because low WSS on the aneurymal wall is linked to growth and rupture risk of aneurysm, the results suggest that using uniform wall thickness for the aneurysmal wall could underestimate risk in aneurysms. Copyright © 2009 John Wiley & Sons, Ltd.